3 LON 18 REPORT ON THE SANITARY CONDITION OF THE CITY OF LONDON, FOR THE YEAR 1850-51, By JOHN SIMON, Esq. F.R.S., medical officer of health to the city of London, ONE OF THE SURGICAL STAFF OF ST. THOMAS'S HOSPITAL. Ordered to be Printed, November 25th, 1851. LONDON: printed by c. dawson, gracechurch street, city. 1851. ERRATUM. Page 48 (Appendix, No. III.) line 8:— In the first column of figures for 827 read 427; In the last column for 1,545 read 1,145. CONTENTS. I. Statistics of Population, Mortality, and Disease page 5 II. Sanitary Powers of the Commission 20 1. In respect of Public Drainage 20 2. In respect of Private Drainage 20 3. In respect of water-supply to Houses 20 4. In respect of Pavements, and their Cleansing. 22 5. In respect of the Cleanliness of Private Premises 23 6. In respect of Slaughter-houses 24 7. In respect of Food 24 8. In respect of Smoke, and of all other nuisances arising in Trades and Manufactures 25 9. In respect of Interments and Burial- Grounds 26 10. In respect of Dwellings of the Poorer Classes 26 11. In respect of Houses unfit for Human habitation 33 12. In respect of appointing Inspectors of Nuisances 33 III. Sanitary Evils out of the Jurisdiction of the Commission 39 Appendix. No. I. Population of the City of London in SubDistricts and in Districts or Unions, as given by Census in 1841 and 1851 45 No. II. Analysis of the Year's Mortality, as to the Four Quarters of the Year, and as to the several Districts and Sub-Districts of the City 47 No. III. Enumeration of Deaths during the three Years 1848-51, distributed in Sub-Districts, and in Districts, or Unions 48 No. IV. The Deaths of the last Three Years stated separately and conjointly, classified according to ages, and distributed in Unions 49 No. V. Comparative prevalence during the Three Years 1848-9, 1849-50, and 1850-1, of such Deaths from acute disease as may chiefly be considered preventable 50 NO. VI. Proposed Schedule of Specification for the Register of Lodging — Houses 51 B 2 At a Meeting of the Commissioners of Sewers of the City of London, held at the Guildhall, 25th November, 1851, Ordered, That this Report be printed, and that a copy be sent to every Member of this Court, and of the Court of Common Council. JOSEPH DAW, Principal Clerk. the SANITARY CONDITION OF THE CITY OF LONDON. Mr. SIMON'S THIRD ANNUAL REPORT. To the Hon. the Commissioners of Sewers of the City of London. Lancaster Place, November 25th, 1851. Gentlemen, I have the honour of laying before you, in the various subjoined tables, such information as will enable you to measure the present sanitary condition of the City of London. 1. The first table (Appendix, No. I.) contains a statement of the present population of the City, as derived from the Registrar-General's recent census; and it compares the existing numbers in each division of the City with those given at the last enumeration in 1841. In examining this table you will observe that, during these ten years, the general population of 6 POPULATION OF THE CITY OF LONDON. the City has increased about 3| per cent.; that this increase has not been uniform through the nine sub-districts of your jurisdiction; that in some it has been unimportant; that in others there has been an actual decrease, extending even to 4,7/10 per cent, on the previous population; while in the whole East London Union the numbers have risen considerably above the aggregate rate of increase, and in the St. Botolph sub-district exceed those of the former census by more than 16 percent. Passing over the minor differences which have taken place in the distribution of the population, I cannot regard that larger increase without apprehension and regret. Probably for the most part it represents the continued influx of a poor population into localities undesirable for residence, and implies that habitations—previously unwholesome by their over-crowdedness—are now still more densely thronged by a squalid and sickly population. I congratulate your Honourable Court on the recent acquisition of powers (to the nature of which I shall presently revert) for the reduction and prevention of this serious evil. 2. The second table (Appendix, No. II.) presents a summary of the City mortality for the year which terminated at Michaelmas last; showing the deaths, as they have occurred, male and female, during each quarter of the year, in the several districts and subdistricts of the City; and including, at the foot of MORTALITY OF THE CITY OF LONDON. 7 each column, a statement of the year's death-rate per thousand of the living in each such district and sub-district. You will observe that, during the 52 weeks, dated from September 29th, 1850, to September 27th, 1851, there have died of the population under your charge 2,978 persons; giving, for the City aggregately, a rate of about 23 deaths for every thousand living persons. The rate of last year was 21.29 per thousand. In my last Annual Report I suggested that the death-rate then prevailing was probably (from temporary circumstances) more favourable than the true average of the City; that it corresponded to the period of recovery from severe epidemic influences ; that it seemed exceptional; and that you might be prepared for this year's mortality showing again a tendency to increase. Such has been the case; and it illustrates the necessity of appealing to cyclical averages for correct intelligence as to the healthiness of a population. To my mind the increased mortality of this year does not indicate any deterioration of the City in respect of sanitary matters under your control: it shows merely that the death-rate, which must be considered our present average for the City, is in truth higher than that which favourable circumstances, foreign to your jurisdiction, last year permitted us to attain. Looking to the total mortality of the last three 8 MORTALITY OF THE CITY OF LONDON. years (the period for which I have had the honour of serving the Corporation) I find that 9,493 deaths have taken place: which, the mean population of the time being 129,256, gives an average rate of 24.48 deaths per thousand per annum. This accords pretty nearly with a death-rate (24.36) deduced from the septennial period 1838-44, during which (according to the Registrar-General) 22,127 deaths occurred in a population estimated at 129,739.* Assuming our City mortality to be accurately represented by these averages, I need not inform your Honourable Court that such a death-rate is unduly high. I have already, in previous Reports, laid before you the materials for measuring its excess,—materials which seem to show that our existing death-rate is nearly the double of that which better circumstances have elsewhere rendered attainable.† It is not to the City alone of metropolitan districts that this high mortality belongs. Unhappily it affects the entire Metropolis; and we may find other * Since 1841, when the Census gave these figures, the limits of the West London Union have been slightly altered. The Inner Temple and Barnard's Inn have been added to it, while part of St. Sepulchre's parish has been taken away. † The death-rate to which I particularly refer in the text, and which I cited in my last year's report, is that of a large district in Northumberland, numbering 27,628 inhabitants, where, during the seven years 1838-44, the mortality was at the rate of only 14 per thousand per annum ; and even in this comparatively low proportion a very distinct share might still be called preventable deaths. MORTALITY OF THE CITY OF LONDON. 9 towns in England, and still more, on the Continent, where the death-rate is higher than under your jurisdiction. Yet your Honourable Court will not doubt, that the standard to be adopted for your estimate of healthiness ought to be the lowest known death-rate; that every avoidable death is an unqualified evil to society; and that, if a mortality of 12, or 13, or 14 per thousand per annum can be reached for one mixed population, there is ample room for discontent among any other population, which finds itself doomed to perish at double the rate of the first. 3. In the third table (Appendix, No. III.) all the deaths of the last three years are enumerated in a form which may enable you to compare one year with another, and one sub-district with another, in respect of their several contributions to the total mortality. 4. In the fourth table (Appendix, No. IV.) are classified, according to the ages at which they occurred, 9,476* deaths of the last three years. This table is arranged in a manner to display its results— (1) for each year separately, and (2) for each Union separately, in order that you may observe what local or annual differences have obtained as to the ages of chief mortality. You will notice that in 3,469 * In the remaining number (17) the particulars of age and residence could not be correctly ascertained. 10 MORTALITY OF THE CITY OF LONDON. instances, nearly three-eighths of the whole, death has befallen children under five years old. Children at this age constitute about a tenth part of the population of the City. They accordingly die at about four times the rate which would fall to them as equal participators in the average mortality of the district. The next table will throw some light on this disproportionate excess of infant deaths. 5. In it (Appendix, No. V.) an enumeration is made of such deaths, during the last three years, as have arisen in consequence of acute disease partially or entirely preventable. They amount to 3,923— more than two-fifths of the entire mortality of the period. I would especially beg the attention of your Honourable Court to the particulars set forth in the successive columns of this table. The first column shows 391 deaths by fever; and of these, without hesitation, I would speak as entirely preventable. Under favourable sanitary conditions fever is unknown. The deaths arising from it for the most part befall persons in the prime of life, whose premature removal, in the midst of their vigour and usefulness, is not only a direct weakening of society, but is also, in respect of orphanage and widowhood, a frequent source to the public of indirect detriment and expense. In the second column, swelled by the epidemic MORTALITY OF THE CITY OF LONDON. 11 visitation of 1849, you will find 902 deaths referred to Asiatic Cholera, and to other kindred diseases. Comparatively few cases of the kind have occurred since Michaelmas 1849; an overwhelming majority belonged to the summer-quarter then terminating, when the Metropolis generally was suffering from the presence of Cholera. I have already had occasion to show you that this frightful pestilence belongs only to localities which, by their general epidemic mortality, have previously been stigmatised as unhealthy; that, over districts otherwise healthy, it migrates without striking a blow; that it may, therefore, with confidence be spoken of as a disease proportionate to removable causes—in other words, as a preventable disease. I cannot pass over these two columns, without begging you to observe what perhaps may be novel to you. If, instead of reckoning the cholera deaths as belonging solely to the one year in which they happened, you reckon them as belonging to the whole term of years which elapsed between the two visitations of the epidemic, and distribute them equally over that period, so as to form an average— say for fifteen years, you cannot fail to notice how largely, in the long run, the destruction by fever (which is always here) surpasses the fatality of that Eastern disease; so much so, that the average annual mortality by the latter probably does not amount to half the fatality of the former. Nor must it be lost sight of, that if the deaths 12 MORTALITY OF THE CITY OF LONDON. by typhus double in number those produced by cholera, the list of persons attacked by the former disease, and thereby for a long while incapacitated and suffering, is immeasurably beyond this proportion. Two or three times the number of deaths by cholera would give you the number of seizures, and enable you to estimate all the direct mischief caused by it; while, in regard of typhus, probably for one death there are twenty cases of protracted illness, tardy convalescence, and injured constitution. Not only are the deaths double in number, but each of them indicates an infinitely larger amount of sickness and suffering not immediately productive of death. The frightful suddenness of the rarer disease, and the condensation of its epidemic fatality into some single year, give it more apparent importance than belongs to the familiar name of typhus; but I can assure your Honourable Court, that if a large amount of preventable death, and a still larger amount of preventable misery, be strong arguments for sanitary improvement and activity, those arguments are more abundantly derivable from the constant pressure of fever and its kindred maladies, than from the sharper but infrequent visitations of the foreign pestilence. In the third column of this table come deaths by scarlatina. Of these, perhaps a certain proportion would occur even under favourable circumstances; for, whatever mayhave been the original derivation of MORTALITY OF THE CITY OF LONDON. 13 the disease, it is impossible to doubt that the severity of its attack mainly depends on conditions peculiar to the person of the patient, and that no perfection of external circumstances will ensure mildness of infection. But on the other hand it is so certain, that, under attacks of the disease at first equally malignant, adequate ventilation with pure air will enable one patient to wrestle successfully against the poison, while another, less favourably circumstanced, will rapidly sink beneath its influence, that I have no hesitation in assuring you, in respect of the 213 deaths registered under this head, that a "majority would have been avoided under improved domestic arrangements. In the fourth column, you will read of 91 deaths by small pox. Your judgment will not be a harsh one, if you assume that 90 of these were the result of criminal negligence. Under the present administration of the Poor Laws, vaccination is not only accessible to all members of the community, but is literally pressed on the acceptance of the poor. Those stupid prejudices, which for some years retarded the universal adoption of Jenner's great discovery, have now died away; the neglect of vaccination must be regarded as the omission of a recognised and imperative duty. Deaths of children, arising in this parental neglect, ought to be considered in the same light as if they arose in the neglect to feed or to clothe; and I am disposed to believe, that the readiest way of bringing this view 14 MORTALITY OF THE CITY OF LONDON. of the case before those uneducated classes, where the omission usually arises, would be to procure Coroner's inquests every year in respect of some half dozen or more instances where the evidence of neglect might happen to be glaring. In the fifth column of the table stand recorded a hundred deaths by the poison of erysipelas, in one form or another; arising sometimes spontaneously, sometimes in connection with the child-bearing state, sometimes in sequel of accidental lesions and surgical operations. My daily experience as a Surgeon, especially as a Hospital-Surgeon, enables me confidently to speak of these diseases as an artificial product of unhealthy exterior conditions. The contrasting results of surgical operations in town and in country —of operations undertaken amid pure ventilation, in spacious cleanly rooms and dry localities, with those undertaken under opposite circumstances (in the dwellings of the poor for instance, or wherever else amid damp, dirt, and over-crowding) and the similar experience which exists as to the origination of puerperal fever, would be quite conclusive as to the fact, that of the 101 deaths under this head, a large majority might have been prevented. Next, in the sixth, seventh and eighth columns, stand deaths arising in the chief acute diseases of infancy, those to which the disproportionate mortality of infants is mainly due. Many careful statistical observations, as well as personal MORTALITY OF THE CITY OF LONDON. 15 Once, convince me that the immense fatality recorded under this head is, to a very great extent, due to obviable causes. To bring this matter distinctly before you, I must take, as a standard of comparison, some district where the general death-rate is sufficiently low to distinguish it as eminently healthy; and in such an one you will notice a marked diminution, not only (of course) in the number of infant deaths, but likewise in their proportion to the total mortality. Such a district is that of the combined parishes of Glendale, Bellingham and Haltwhistle, in the county of Northumberland. In it the general death-rate is 14; in the East and West London Unions of the City of London, the general deathrate is 26.73. In the former district, children under five constituting more than an eighth of the population 1/7.6, their death form about a quarter of the whole mortality; while in the latter district, where the children are in smaller proportion— namely about 1/9 of the population, their deaths are not much less than half 1/2.24 of the whole mortality. Thus, in the healthier district they die at less than double the average rate for all ages; in the unhealthier, at more than four times that average. A still better method of district comparison, is to arrange in a series the death-rates prevailing in several localities for persons over Jive years of age, and, side by side with this column, another for the 16 MORTALITY OF THE CITY OF LONDON. death-rates of children under Jive years of age. The first column will of course indicate very well the relative sanitary conditions of the districts; but the differences between them will be expressed far more clearly, and, as it were, in a magnified form, in the column of infantine death-rates. Thus, for instance—to repeat the comparison just instituted between the Northumberland and the London district; the death-rate for all ages over five, is about 12 in the former district, and nearly 15 in the latter; a difference quite sufficient to establish the inequality of their sanitary conditions. But, how much more strongly is this disparity expressed in the comparison of the infantine deathrates—26.5 for the healthier district, 107.57 for the unhealthier one! Nothing can be more conclusive than the evidence afforded by statistics, as to the dependence of high infantine mortality on the general causes of endemic unhealthiness. My own observation within the City gives complete confirmation to this view, showing me that the diseases specified in my table (diarrhoea, bronchitis and pneumonia, hooping cough, croup and measles, hydrocephalus and convulsions) however various in nature they may seem, and however apt you may be to dissociate their occurrence from the thought of local causation, yet unquestionably multiply their victims, in proportion to the otherwise demonstrable unhealthiness of a place, owe most of their fatality to local causes, and MORTALITY OF THE CITY OF LONDON. 17 may, therefore, to a great extent be disarmed of their malignity. The last column gives the total of those which have preceded it, and shows, out of 9,493 deaths, 3,923, all from acute disease, in intimate dependence on local and obviable causes. It will be a very moderate computation with respect to these deaths, if we estimate that two-thirds of them might have been hindered. And yet it is not only by acute disorders, that preventable death succeeds in ravaging the population. If we turn to the examination of chronic ailments producing death, we may quickly recognise many indications of their preventability, and may satisfy ourselves that here also the general mortality might be very largely reduced. Look, for instance, at the whole immense class of scrofulous diseases, including pulmonary consumption, a class probably causing, directly or indirectly, at least a quarter of our entire mortality; and consider the vast influence which circumstances exert over its development. Of such circumstances some lie within your control, and affect masses of the people; but the more special causes of chronic disease lie rather out of your jurisdiction, and the option of avoiding them is a matter of individual will. Vicious habits and indiscretion, a life too indolent, or too laborious, poverty and privation, vicissitudes of weather and temperature, intemperance in diet, unwholesome c 18 MORTALITY OF THE CITY OF LONDON. and adulterated food, and, not least, inappropriate marriages tending to perpetuate particular kinds of disease; these words may suggest to you, briefly, these various influences, within the sphere of private life, by which the aggregate death-rate of a population is largely enhanced, and the control of which, if attainable, lies almost entirely at the discretion of the classes subject to their operation. Considering all these causes, and the needless waste of life occasioned by them, I can have little doubt that as much might be done by individuals, under the influence of improved education, to lessen the mortality from chronic disease, as by sanitary legislation to stay the sources of epidemic death. And, regarding both classes of disease together, those, on the one hand which are of endemic origin (arising in imperfect drainage, in defective watersupply, in ill-devised arrangement of buildings, in offensive and injurious trades, in the putrefaction of burial-grounds, and the like) with these classes, on the other, which arise in the circumstances of individual life, I can have no hesitation in estimating their joint operation at a moiety of our total death-rate, or in renewing an assertion of my last years Report, " if the deliberate promises of Science be not an empty delusion, it is practicable to reduce human mortality within your jurisdiction to the half of its present average prevalence." To revert, however, to your more special branch of the subject,—I have thought the present a MORTALITY OF THE CITY OF LONDON. 19 venient time for indicating to you the pressure of preventable death, arising in acute disease, because of the great addition which you have recently gained to your powers for enforcing prevention. That an average death-rate of nearly 25 per thousand per annum prevails in the City; that three-eights of your mortality consists in a premature extinction of infant life ; that fatal disease, in more than two-fifths of its visitations, is of a kind which operates endemically and preventably; these are the facts to which I have appealed, as my evidence of the need for sanitary activity and perseverance. On other occasions I have endeavoured to set before you what are those agencies hostile to life, which affect the masses of an urban population; and during the last three years your Honourable Court has shown its recognition of these causes, and has devoted attention to the means of counteracting them by appropriate sanitary measures. In too many instances, the powers first given you by the Legislature were inadequate to this great purpose. But now, armed with the further authority of your new Act of Parliament, you enjoy such means for sanitary improvement as have never yet been possessed by any Corporation in the country; such means as, judiciously wielded, cannot but produce the greatest advantage to persons living under your jurisdiction. As you are only now entering on the exercise of c2 20 SANITARY POWERS OF THE COMMISSION. these powers, it may be convenient that I should submit to you a brief account of them, and I gladly turn from contemplating the spectacle of preventable death, to analyse the means of prevention now vested in you by the Legislature. 1. In regard of public drainage or sewerage, the first and most elementary condition of endemic health, I need hardly tell you that within the City, your powers are absolute. You have entire and sole responsibility for the construction and maintenance of sewers, for their cleaning or flushing, and for the prevention of noxious effluvia from their innumerable gully-holes. 2. In the all-important particular of housedrainage, your authority is sufficient for every purpose. You can order the complete abolition of cesspools ; the construction of drainage in any premises within fifty feet of a sewer; its repair, cleansing, or renewal, wherever it may be disordered: and not only can you order these works to be done, but—failing the owner's compliance with your notice, you can devolve the performance of his duty on your own workmen, and can recover your expenses from the recusant. 3. In regard of water-supply to houses, your powers are equally cogent, though the unsatisfactory condition of the water-trade continues a serious SANITARY POWERS OF THE COMMISSION. 21 obstacle to their effective employment. You have authority here, as with house-drainage, to order the construction of all necessary apparatus, and to enforce the fulfilment of your order. Under both these heads, you possess a power hitherto but imperfectly used, the complete and constant exercise of which I would strongly recommend to your Honourable Court. In all those clauses of your Acts of Parliament, which relate to private works of house-drainage and water-supply, there occurs a very important phrase:—such works shall be constructed" to the satisfaction of the Commissioners." Now, of private works effected under the authority of your Act, during the last three years, a certain, not inconsiderable, share proves inoperative and bad. The mere overflowing of a waterbutt (and in numberless instances this is the arrangement evasively adopted under your orders) can never suffice for the effectual cleansing of housedrains. I need scarcely inform you that an obstructed drain and choked privy, wherever they occur, are equivalent to a cesspool; shedding abroad the same effluvia, and producing the same deadly results. No gain is gotten to the wholesomeness of a house, by substituting for its former cesspool an equally offensive and inoperative drain. To my knowledge, much of the drainage done during the last three years is liable to this risk; and it appears 22 SANITARY POWERS OF THE COMMISSION. to me indispensable that you should exert direct supervision against so serious an evil. I would recommend to your Honourable Court that, in issuing orders for the construction of drainage and water-supply, you should require a full specification to be delivered you of the works about to be undertaken, and should distinctly decide as to their sufficiency; or by a still simpler process, that you should fix and determine a certain standard of combined works; a model plan, in short, for housedrainage, privies, and water-supply, and should direct your Inspectors to certify to you the sufficiency of only such works as might accurately correspond to this design. I cannot but regard it as a grave calamity, that the general supply of water to the City remains beyond your control, in the hands of irresponsible traders ; for its imperfect adaptation to the requirements of the public constitute the largest sanitary evil of the day. 4. You have entire control over the pavement of every public way within the City, for its construction, maintenance, and cleansing; and in this respect you exercise a power of great sanitary value. The preservation of cleanliness along the whole extended surface of the City, including its many hundred courts and alleys, is indeed a branch of your functions which can hardly be SANITARY POWERS OF THE COMMISSION. 23 mated for its importance; and the fines which you have the power of levying from your contractors, whenever the scavenging is neglected, are useful securities for the general performance of their duties. It lies within your power to order, wherever you may think fit, the employment of the hose and jet for the purpose of surface-cleansing in courts and alleys: and, I may add, that the advantages of this most effective sanitary process have been highly appreciated where you have directed its application. In some of the poorer localities, complaints have arisen in a matter relating to the pavements, where you are not able to afford the complainants effectual relief: viz., with respect to certain inhabitants throwing refuse and offensive matters from the houses into the public way, so that nuisance is created. I have already suggested to your Honourable Court, and I beg leave here to repeat, that in the 41st clause of the City Police Act provision is made for the prevention of this particular offence, and that your four Inspectors are manifestly unable to relieve the Police Force of their legal responsibility in the matter. 5. Your powers for enforcing the wholesome cleanliness of private premises are equally considerable. You can order the removal of offensive matter, the purification and whitewashing of premises, and the abatement of any nuisance arising in 24 SANITARY POWERS OF THE COMMISSION. conditions of filth. In case of need, as shown by a medical certificate, you can summon the offender before your Court; and (under your new Act) you can punish with a heavy fine any repetition of the nuisance against which your order has once been issued. 6. So long as slaughter-houses are tolerated within the City (and it is to be hoped this may not be long) you have power to regulate their use, according to your discretion, with a view to their cleanliness and better management; and in case of disobedience to your orders, you have power to enforce the temporary suspension of slaughtering. Your new Act renders illegal any slaughtering in cellars, or any keeping of cattle there: and it prohibits that offensive exposure of putrescent hides, which has so often been complained of in the vicinity of Leadenhall Market. 7. In close connection with the regulation of slaughter-houses, your new Act gives you authority in a matter hitherto quite foreign to your jurisdiction, but where your vigilance may no doubt be exercised with great advantage to the public health. You are authorised to appoint Inspectors of slaughter-houses and of meat; and these officers are required to inspect shops, markets, and slaughterhouses, and to seize and destroy any meat which may appear to them unsound or unwholesome. SANITARY POWERS OF THE COMMISSION. 25 A further clause of very extensive application enables you to deal generally with all cases, where unwholesome provisions are exposed for sale; and this clause is so constructed as to include and render penal all those fraudulent adulterations of food which render it detrimental to health. 8. You are invested with important authority against such trades and occupations as are offensive or injurious to their neighbourhood. Under your former Act, you can subject to penalties any person who shall "roast or burn, boil, distil, or otherwise decompose any root, drug, or other article or thing, in any house or building, and thereby cause offensive or injurious smells or vapours to be emitted therefrom, so as to become a common nuisance;" and the same Act also gives you a very inoperative clause against such nuisance-causing manufactories as might begin to work in the City after the commencement of that Act. Your new law enacts that everything practicable shall be done for the suppression of all nuisances arising in manufactures and the like:—that, after the first of January next, every furnace used in the City shall be such as to consume its own smoke; and that whatever trade or business may occasion noxious or offensive effluvia, or otherwise annoy the inhabitants of its neighbourhood, shall be required to employ, to your satisfaction, the best known means for preventing or counteracting such annoyance. 26 SANITARY POWERS OF THE COMMISSION. 9. You have certain powers to which I adverted in my former Report, as likely to come into activity whenever the injurious practice of intramural burial might cease; powers, namely, relating to the disposal of dead bodies in certain specified cases: and under your new Act, you have acquired some further authority (likewise only to be exercised after that cessation, and with the consent of the Bishop of London) to appropriate the disused burial-grounds for purposes of improvement. At the time of my last Report I looked "forward to the complete discontinuance of burial within your territory as a matter for warm congratulation among all who are interested in the cause of sanitary improvement and it is with proportionate disappointment and regret, that I have now to report to you that the Order in Council, which was to have closed all metropolitan burial grounds, has never yet been issued; and that negociations, conducted by the General Board of Health for the purchase of a sufficient extramural cemetry, were suddenly arrested at the close of the last session of Parliament. Your powers in relation to these matters remain of course meanwhile inoperative. 10. The most important additions made to your power relate to the dwellings of the poor, and are embodied chiefly in the tenth section of your new Act. The definition of "lodging-house "given in this clause is so extensive, and the power of regulation conceded SANITARY POWERS OF THE COMMISSION. 27 to you is so unconditional (where once the necessity for your interference is shown) that your Honourable Court can now exert your authority for every legitimate object, in respect of all the poorer houses in the City. The definition is, that " the expression common lodging-house shall, for the purposes of this Act, mean any house not being a licensed victualling-house let, or any part of which is let, at a daily or weekly rent not exceeding the rate of three shillings and sixpence per week; or in which persons are harboured or lodged for hire for a single night, or for less than a week at one time; or in which any room let for hire is occupied by more than one family at one time." And your powers are to the following effect:—"Wherever overcrowding has taken place, unwholesomely or indecently,—wherever undue illness has prevailed, —wherever from any one of several causes the house is unfit for occupation, you can require its immediate registration; you can then make such rules as you think fit for the maintenance of decency and health; and you can enforce conformity to those regulations, with appropriate penalties. The terms of the clause throw on your Medical Officer the responsibility of initiating these proceedings ; and his task in the matter will be one of anxiety and arduousness. In most other clauses of your Acts of Parliament, an alternative is allowed as to your taking the opinion " of the Officer of 28 SANITARY POWERS OF THE COMMISSION. Health, or of any two duly qualified Medical Practitioners in this clause you are expressly restricted to the certificate of your Officer of Health. In my two former Reports, I have addressed you at length on those conditions relative to the dwellings and social habits of the poor which made the enactments of this clause indispensable; and I look forward to its operation with a sanguine belief that it may be rendered one of the most important boons ever conferred on the labouring classes of a community. I subjoin to my Report the schedule which I would suggest for the registration of lodging-houses, and which (as you will observe) requires detailed information as to every sanitary particular of the dwelling (App. No. VI.) I would recommend that in every case, where registration is made, the owner's specification of these particulars should be accompanied by a written certificate from your Inspector; testifying (in some such form as that annexed to the schedule in my Appendix) first, to the accuracy of the statement, and secondly, to the general condition of the house. With respect to the rules, which, under authority of this clause, you may find it requisite to lay down for better regulating the residences of the poor,— the conditions for which you have to legislate are so various and complicated, that no formula will apply universally; and you will often be called on to adapt special rules to particular cases as they come before SANITARY POWERS OF THE COMMISSION. 29 you. I can therefore only venture at present to offer you general suggestions on the subject. You will find that the houses in which your interference is required, fall into three cases, characterised as follows:—(1) Where the house is let in several independent holdings (often as many holdings as rooms) each occupied by a single family and no more, and paid for at a rent not exceeding 3s. 6d. per week;—(2) Where the house is thus let in several independent holdings, and where the renter of each or any portion, admits other persons to share his holding with him, on their payment to him of a sub-rent per week or per night, so that a room comes to be occupied by more than one family at a time;— (3) Where the entire house, or all such part as is let in lodgings is under the direct arrangement of a single resident proprietor or keeper, where the lodgings are let at per night, and where many persons not belonging to one single family are lodged together in some single room, or in various single rooms of the house. Of the first arrangement, where a single room is the residence of a single family, you have innumerable illustrations in the City; as, for instance, in the large houses of Windsor Street (to which I have recently drawn your attention) where in one house there are sixteen such holdings:—of the second arrangement—the most abominable and brutalising which can be conceived, you have sufficient illustrations in Plumtree Court:—of the third, 30 SANITARY POWERS OF THE COMMISSION. tively little known in the City, there are instances in Field Lane. In respect of the first class of houses, I should be disposed to look upon each holding as the house of its occupier, and not to interfere within his threshold, except on the ground of some commanding necessity. I would require only that the general arrangements of the house should be adapted to the number of its holdings; that, for instance, numerous families should not be left competing for the use of a single privy, but that such accommodation should be provided in strict proportion to the requirements of the inmates; that every room should be efficiently ventilated ; that water should be supplied to the highest occupied part of the house, and a water-tap and sink furnished on every floor; that the dust and refuse of the house should be removed at least once daily. In dealing with the worst specimens of this class, it may be requisite to go further than I have here intimated; and it appears to me that for this purpose your Honourable Court must address your regulations not to the tenant, but to the landlord. He, I apprehend, must be held responsible for the decent and wholesome condition of his property, and for such conduct of his tenants as will maintain that condition. Seeing the punctuality with which weekly visitation is made for the collection of rents in these wretched dwellings, it would not be unreasonable, I think, to insist on some such regulation as the SANITARY POWERS OP THE COMMISSION. 31 following:—The owner of his house, or his agent, or collector, shall visit each room on an appointed day, at least once weekly, between the hours of eleven and three; he shall see that the floor and other woodwork of the room have been properly washed on that day, that the room be free from all dirt, rubbish, or offensive smell, that no objectionable trade be pursued in it, and that it be generally in good and proper repair; he shall see that the premises* generally be in a clean and wholesome condition, that water be sufficiently supplied, and that dustmen's work be regularly performed; and, failing either of the two latter conditions, he shall forthwith lay complaint thereof before your Commission; in case of any inmate suffering from cholera, small-pox, erysipelas, or any kind of fever, the owner, or his agent, or collector, shall immediately give notice of such illness to the Inspector of his district; and at the meeting of the Commission next after such notice, he shall, if required, attend your Court, to receive any order which you may issue for reducing the numbers of his lodgers, or for improving the condition of his house, or for employing any disinfectant process: and he shall fulfil any such order within the time therein specified. In a proceeding so experimental as the present, I cannot assure you of infallible means for meeting * Namely—passages, staircases, area, cellar, yard, privy, &c. ; and if common privies and urinals exist, he shall provide for the cleansing of these, where requisite, at least once daily. 32 SANITARY POWERS OF THE COMMISSION. every evil contingency; but it seems to me that a regulation having the general tendency here indicated, enforced by moderate penalties, would work an important revolution in the economy of dwellings affected by its operation, would render it indispensable to the landlord of such holdings to promote cleanly and decent habits among his tenants—even to obtain security for their good behaviour, and would make it difficult or impossible for persons of opposite habits to obtain holdings under a landlord who would be virtually punishable for their misconduct. Such a regulation would apply, as I have said, to the lowest and filthiest specimens of the first-class of lodging-houses; for, to the large majority of that class less stringent rules would suffice; and it would apply most usefully to the second-class of lodginghouses—those in which the single rooms of a house are severally occupied by more than one family. So great are the physical and moral evils attending this indiscriminate admixture of adult persons of both sexes (as I have submitted to you in my former reports) that I entertain no doubts of the neceessity for prohibiting it in the most absolute manner. A regulation, to the following effect would, probably, fulfil the purpose contemplated by the law, and would disperse these loathsome heaps of disease, destitution, and profligacy: viz.—There shall not be lodged in this room, at any one time, more than two persons over fourteen years of age, if of SANITARY POWERS OF THE COMMISSION. 33 ferent sexes; nor more than such persons, if. they be all of one sex.* This order, in addition to its wholesome influence on the second class of lodging-houses, would apply beneficially to the third class ; and, in further relation to the latter, there would probably be required various minor regulations with respect to facilities for washing, for lighting, for ventilation, and the like, which admit of being fixed in detail, only as each particular case comes under your notice, with its deficiencies recorded in the schedule of its registration. 11. In addition to this power of regulating lodging-houses, a further authority has been conceded you by the Legislature, for the amendment or removal of houses presenting aggravated structural faults. "Wherever your Officer of Health may certify to you that any house or building is permanently unwholesome and unfit for human habitation, you are empowered to require of the owner (or, in his neglect, yourselves to undertake) the execution of whatever works may be requisite for rendering the house habitable with security to life. Finally,—under your former Act you were authorised, and indeed required, to appoint Inspectors * The number would be proportioned to the cubical contents of the room, and its facilities for ventilation, of which mention would be made in the registration-schedule of the house. D 34 SANITARY POWERS OF THE COMMISSION. of Nuisances, whose duties were to consist in the following particulars :—They were to superintend and enforce the due execution of all duties to be performed by the scavengers; to report to your Commission all breaches of your rules and regulations; to point out the existence of nuisances; to record whatever complaints might arise in relation to the supply of water, or in relation to any infraction, either of the Act, or of any regulations made by you under its authority for the preservation of order and cleanliness, and for the suppression of nuisances. Hitherto your Honourable Court has deemed it sufficient compliance with the terms of the Act, to engraft the functions above described on the office of your previously appointed Inspectors of Pavements; and these Officers have endeavoured very diligently to fulfil the multifarious obligations thus imposed on them. During the past year it has become obvious to me that this arrangement of their duties is inconvenient, and that the occupation of their time as Inspectors of Pavements prevents them devoting the requisite number of hours to the other important duties. I need hardly add, for the information of your Honourable Court, that the immense increase of sanitary business implied in your new Act (an increase probably equivalent to doubling or trebling the former amount) renders a continuance of the former arrangement still less possible than CONCLUSION. 35 fore; the important functions assigned to your Inspectors of Nuisances will now require to be discharged, under the superintendence of your Officer of Health, with uninterrupted assiduity and vigilance; and I would therefore take the liberty of begging your Honourable Court to refer this subject to the consideration of your Committee, together with some other points relative to the administration of your new powers. Here, gentlemen, terminates my statement of the powers now vested in you for the maintenance of the public health. Authority so complete for this noble purpose has never before been delegated to any municipal body in the country. In exercising the means of such wide beneficence, your Honourable Court will be discharging duties of immeasurable importance to the public welfare; and those who have the honour and responsibility of giving you professional advice will have a task of more than ordinary difficulty. It is easy to foresee the numerous obstacles which interested persons will set before you to delay the accomplishment of your great task. Sometimes technical objections will be raised to your proceedings: sometimes vexatious delays and evasions will occur in the fulfilment of your injunctions. When your orders are addressed to some owner of objectionable property—of some property which is 36 CONCLUSION. a constant source of nuisance, or disease or death; when you woudd force one person to refrain from tainting the general atmosphere with results of an offensive occupation ; when you would oblige another to see that his tenantry are better housed than cattle, and that, while he takes rent for lodging, he shall not give fever as the equivalent;—amid these proceedings, you will be reminded of the "rights of property," and of "an Englishman's inviolable claim to do as he will with his own." Permit me, gentlemen, to remind you that your law makes full recognition of these principles, and that the cases in which sophistical appeal will oftenest be made to them, are exactly those which are most completely condemned by a full and fair application of the principles adverted to. With private affairs you interfere, only when they become of public import; with private liberty, only when it becomes a public encroachment. The factory chimney that eclipses the light of heaven with unbroken clouds of smoke, the melting-house that nauseates an entire parish, the slaughter-house that forms round itself a circle of dangerous disease— these surely are not private, but public affairs. And how much more justly may the neighbour appeal to y ou against each such nuisance, as an interference with his privacy; against the smoke, the stink, the fever, that bursts through each inlet of his dwelling, intrudes on him at every hour, disturbs the enjoyment and shortens the duration of his life. And 37 CONCLUSION. for the rights of property—they afe not only pecuniary. Life, too, is a great property, and your Act asserts its rights. The landlord of some overthronged lodging-house complains, that to reduce the numbers of his tenantry, to lay on water, to erect privies, or to execute some other indispensable sanitary work, would dimmish his rental: in the spirit of your Act, it is held a sufficient reply, that human life is at stake, and that a landlord, in his dealings with the ignorant and indefensive poor, cannot be suffered to estimate them at the value of cattle, to associate them in worse than bestial habits, or let to them for hire—at however moderate a rent, the certain occasions of suffering and death. And indeed,gentlemen, the mere pecuniary import of life thus squandered is not inconsiderable. The costs of medical attendance on these superfluities of disease are heavy items of parochial expenditure; and although much of the undue mortality is of children, and consists in the premature extinction of life that hitherto has no market value (costing only the tears that are shed for it) yet there likewise occur among your preventable deaths, very many cases in which adult life is sacrificed, with all its strength and utility, and where, beside the wasted capital which that loss implies, there often remains for the district which has poisoned the man, an entailment of orphanage and widowhood. Nor again, can it be questioned, that year by 38 CONCLUSION. year, as general education advances, the sanitary condition of a district will be an important element in determining the value of its property. In engaging houses, men will not only look to rent, and to rates on rent; they will look also to rates on life, and will doubt the cheapness of a town residence, however small in rental, where their lease of life must be shortened from its intended duration, and form part of an average mortality two-thirds higher than in the suburbs. It is an instinct in this direction, or perhaps the guidance of knowledge, that within late years has given so much extension to suburban residence, and has carried numbers of the wealthier inhabitants of the City to dwell so far from their places of daily business: and the same instinct or knowledge yearly acts more towards the less affluent classes, urging them to fly as far as possible beyond the smoke and crowding and unwholesome vapours of the metropolis. I entertain great hope and little doubt, that within a few years, the working classes will have organised for themselves extensive means of suburban residence; that vast barracks of modelhouses, rising on healthier soil and amid purer atmosphere, will receive hundreds of thousands of inmates from those classes of society which now throng the courts and alleys of the metropolis; and that by this spontaneous emigration, in so far as it may affect the City, great assistance will be given to those endeavours which will be made, under CONCLUSION. 39 authority of your Act, to thin the court-population of the City, and to diminish the too dense array of houses inhabited by the poor. As I look to the poor-rates of the City of London, as well as to the other circumstances just adverted to, I feel the deepest conviction that property, no less than life, is interested in the progress of sanitary reform: and once again, most earnestly, I beg leave to congratulate your Honourable Court on the acquisition of powers, conferring on you the inestimable privilege of doing so much good for those whom you represent, and for the often unrepresented poor; of relieving so much suffering; of prolonging so much life. That much improvement remains to be accomplished within your province, is a certainty which I have endeavoured here, as on former occasions, plainly to set before you. But I cannot close my Report without adverting to the feet, that both within and around the City, there are sanitary evils for which you are not responsible—evils beyond your control—powerful causes of disease in hourly operation; and that these are so extensive in their agency, as to neutralize much of the good which it lies in your competence to effect. The mere fact, that for the Metropolis generally there is hitherto no sanitary law, such as you possess for your territory, is an evil to you. When, at the commencement of next year, you will be proceeding 40 CONCLUSION. to suppress the several nuisances against which you are armed, when the various trades of the City will have ceased to send forth smoke or stink, you can raise no barrier against invasions from around; southward, you cannot exclude the unwholesome airs wafted from the river and from across it; nor on either side, cast or west, the soot that showers down from innumerable shafts encircling you; nor northward, the odours that rise from the shambles of Clerkenwell. And likewise within the City there will be remaining—out of your control, unremedied evils, the existence of which has long been denounced, and the removal long expected. In 1849, with the cholera amidst us, great exertions were made, and greater promises. In that dreadful week, when two thousand victims of our metropolitan population fell beneath its poison; when every household, from hour to hour, trembled at the visible nearness of death; the public was scared out of indifference. If the visitation could have been bought away, at the expense of doubling all local rates in perpetuity, no doubt the sacrifice would have been made. Public opinion was kindled to overwhelm all opposition. The metropolis was to be drained afresh; the outfall of sewerage was no longer to be beneath our windows; the river was to be embanked; its rising tide was no longer to make our sewers disgorge their poisonous contents into our streets and houses; CONCLUSION. 41 dead bodies in their decay, were no more to desecrate the breathing-space of the living; water was no longer to be supplied—clumsily, insufficiently, and unwholesomely, at the discretion of private capitalists : all was to be amended. For participation in these advantages, the City had to look beyond its own representatives, and to await the more comprehensive measures of Her Majesty's Government. Two years have elapsed, and none of the measures referred to has made visible progress. The waterquestion remains unsettled; arrangements for extramural interment of the dead have been disconcerted at what seemed the moment of their completion; the river still receives the entire sewage of this immense metropolis, and still at each retreating tide, spreads amid the town, as heretofore, its many miles of foœtid, malarious mud. In justice it should indeed be remembered, that any one of the required amendments could only be the result of long preparatory labour, and that its organisation would often of necessity be the travail of some single mind, not insusceptible of fatigue. Particularly as respects the scheme (now understood to approach its maturity) for the complete drainage of the Metropolis, it cannot be overlooked that very extensive surveys, superficial and subterranean, with innumerable drawings and specifications, were necessary to the construction of so comprehensive a plan. But neither can it be disguised or disregarded, that 42 CONCLUSION. meanwhile, in the absence of these sanitary works, there are dying needlessly and prematurely thousands of the population ; that preventable death, hitherto unprevented, is proceeding at its accustomed pace ; that children continue to perish at three or four times their due rate; that time, which carries us from one visitation of the great epidemic and obliterates the remembrance of our alarm, also, too probably, carries us towards the day of another outbreak; that typhus—our home-bred and daily visitant, rehearses the same warnings as heretofore, moving uniformly onward, like the shadow on a dial, toward the hour when that Eastern pestilence may again be here. Therefore, gentlemen, I have felt it my duty to represent to you that, in the promotion of those metropolitan works, the population of the City of London have an incalculable interest;—that the emancipation of human life from such fetters of disease as weigh on it, can never even approximate to completion within your City, while the saturated burial-grounds still continue to receive their annual multitudes of the dead, while the administration of the water-supply interposes an effectual hindrance to your mo6t important functions, and while the river, contaminated and un-embanked, diffuses injurious miasms through the whole extent of your jurisdiction. And I would further venture to urge on the consideration of your Honourable Court, that your legitimate influence with Her CONCLUSION. 43 Majesty's Government and with Parliament—your influence as trustees of the Public Health for so large a constituency, exerted in furtherance of those metropolitan reforms to which I have adverted, would be tending—not only to the general good, but directly and eminently to the sanitary advantage of the City of London. I have the honour to remain, Gentlemen, Your obedient Servant, JOHN SIMON. APPENDIX. No. I. Population of the City of London in Sub-Districts and Unions as given by Census in 1841 and 1851. Union. East London. East London. Total of East London Union. West London. West London. Total of West London Union. City of London. City of London. City of London. City of London. City of London. Total of City of London Union. Total Population of the City. Sub Districts. St. Botolph Cripplegate North. South. South-W. North-W. South. South-East North East Census of 1841. 20,395 19,346 39,741 12,243 16,696 28,939 8,969 12,610 12,131 10,753 12,282 56,745 125,425 Census of 1851. 23,741 20,852 44,593 12,529 16,105 28,634 9,315 12,016 11,594 10,521 13,009 56,455 129,682 Increase ( + ) + 3,346 + 1,506 + 4,852 + 286 - 591 - 305 + 346 - 594 - 537 - 232 + 727 -290 + 4,257 Decrease ( - ) N.B. In preparing this Table, I have deducted the Workhouse Population of each Union from the Sub-District in which the Workhouse happens to be situated, and have distributed its amount among the several Sub-Districts of the Union in the proportion of their respective general populations. 46 APPENDIX. Note to No. II. In making the calculations on which the Rates of the following Table are founded, I have reckoned the Workhouse Population and Workhouse Deaths of each Union as forming part of the aggregate population and aggregate mortality for such Union respectively; and in proceeding to calculate the Sub-District mortality, I have distributed, among the several Sub-Districts, the population and mortality of their Union Workhouses, apportioning these in the ratio of the general Sub-District Population, so as to prevent the high Workhouse Mortality from telling unjustly against the Sub-District in which the building happens to be situated. Hospital Deaths have been distributed according to the residences of the patients; so that the North Division of the West London Union (in which St. Bartholomew's Hospital is situated) now retains only its just proportion of deaths. No. II. Analysis of the Year's Mortality, as to the Four Quarters of the Year, and as to the several Districts and Sub-Districts of the City. Population of City 129,682 In Unions or Registrars' Districts East London Union, 44,593 West London Union, 28,634 CiTy of London Union, 56,455 In Registrars' Sub-Districts. Saint Bptolph Cripplegate, Workhouses, North, South, Workhouse. s. w. N. W. South, S. E. N. E. Workhouse. 23,435 20,582 575 12,350 15,875 409 9,184 11,847 11,431 10,373 12,826 794 Deaths in four quarterly periods terminating as follows: M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. 47 54 68 57 7 25 29 33 35 37 8 6 27 21 24 21 25 24 24 31 19 29 16 6 I.1850,December 28th 672 deaths 101 125 32 62 72 14 48 44 49 55 48 22 II. 1851, March 29th 87 67 77 63 19 30 51 36 46 43 11 11 28 31 22 26 39 42 27 29 35 32 12 12 154 140 49 87 89 22 59 48 81 56 67 24 III–, June 28th 767 deaths 72 43 58 43 26 22 45 47 38 41 11 10 26 18 22 16 40 35 35 35 31 25 15 13 115 101 48 92 79 21 44 38 75 70 56 28 IV.–, September 27th 663 deaths 63 60 62 43 13 25 53 23 38 35 9 2 24 16 21 18 29 24 23 18 17 25 14 13 123 105 38 76 73 11 40 39 53 36 42 27 Deaths for the whole year, 2,978. In Registrars' Sub-Districts. 269 224 265 206 65 102 178 139 157 156 39 29 105 86 89 80 133 125 109 108 102 111 57 44 493 471 167 317 313 68 191 169 258 217 213 101 In Unions or Registrars' Districts 1131 698 1149 Rate of Mortality per thousand of the population ; for the City aggregately, 22.96 For Sub-Dis. 24.51 26.32 * 27.69 21.79 * 22.29 15.85 24.04 22.40 18.16 * For Unions 25.36 24.37 20.35 APPENDIX. 47 48 APPENDIX. No. III. Enumeration of Deaths during the three Years 1848-51, distributed in Sub-Districts, and in Districts, or Unions. East London Union. 1848-9. * 1849-50. 1850-1. Total. St. Botolph Sub-District 613 462 582 1657 Cripplegate Sub-District 659 503 549 1711 Entire East London Union, or District 1272 965 1131 3368 West London Union. •a North Sub-District 827 371 347 1545 South Sub-District 669 351 351 1371 Entire West London Union, or District 1096 722 698 2516 City of London Union. South-west Sub-District 310 193 208 711 North-west Sub-District 267 190 190 647 South Sub-District 284 233 279 801 South-east Sub-District 233 202 236 671 North-east Sub-District 286 242 236 764 Entire City of London Union, or District 1380 1065 1149 3594 Total Mortality of the City 3763 2752 2978 9493 * During the year 1848-9 there were fifteen cases of death, in the registration of which the residence was imperfectly recorded. These cases, therefore, though included in the total (3763), are excluded from the Subdistrict enumeration. See also Note to No. IV. 49 No. IV. Deaths of the last Three Years stated separately and conjointly, classified according to Ages, and distributed to Unions. Deaths in the Population of the City of London. Under 5 Years. Under 10 Years. Under 15 Years. Under 20 Years. Under 30 Years. Under 40 Years. Under 50 Years. Under 60 Years. Under 70 Years. 70 and upwards. Totals. During the year 1848-9 1243 202 92 90 292 345 396 355 366 367 3748 During the year 1849-50 1032 83 44 70 166 200 251 254 318 334 2752 During the year 1850-1 1194 124 48 60 169 227 248 261 303 342 2976 * Sum of three years 3469 409 184 220 627 772 895 870 987 1043 9476 9476 Deaths of the last three years distributed in Unions. East London Union 1411 143 56 60 200 247 279 265 340 367 3368 West London Union 857 89 56 72 198 224 257 261 269 232 2515 City of London Union 1201 177 72 88 229 301 359 344 378 444 3593 APPENDIX. * During the year 1848-9 there were fifteen cases, and during the year 1850-1 two cases, in respect of which the particulars of age or residence could not be ascertained with sufficient accuracy for the purposes of this table. The addition of these to the total amounts in the table would give the correct number of deaths for those years, viz. 3763 and 2978 respectively, and 9493 for the general total. I have likewise been enabled to introduce some corrections in my account of the mortality during the first year. At that time my means for accurate registration of deaths were necessarily imperfect; and my first death-list contained 36 cases (chiefly of certain patients in St. Bartholomew's Hospital,) which ought not to have been reckoned to the mortality of the City. In carefully revising my tables of that date, I have excluded these cases, and have thereby reduced the total number of deaths for the year in question to 3763. In the report referred to it was estimated at 3799. 50 No. V. Comparative prevalence during the Three years 1848-9,1849-50 and 1850-1 of such Deaths from acute disease as may chiefly be considered preventable. (See Report for 1850, pp. 15, 16, and present Report, p. 10) In the Years terminating as follows:— Fever, &c. Cholera, Dysentery, Epidemic Diarrhoea Scarlet Fever Cynanche Maligna, &c. Small Pox, &c. Erysipelas, Puerperal Fever, Phlebitis, &c. Diarrhoea, Bronchitis, and Pneumonia of infants, under 3 years of age. Zymotic Disorders commonly occurring in Infants: Hoopingcough, Croup, Measles. Hydrocephalus, and Convulsions of Infancy. Total of preceding columns. At Michaelmas 1849 166 825 135 17 44 285 196 264 1932 „ 1850 118 54 32 33 40 243 124 219 863 „ 1851 107 23 46 41 17 340 272 282 1128 Total of three years 391 902 213 91 101 868 592 765 3923 APPENDIX. APPENDIX. 51 No. VI. Proposed, Schedule of specification for the Register of Lodging-houses. House situate at No. Name and Address of Owner Number of Floors (including Cellars and Lofts) „ Rooms „ „ „ „ Account of Booms separately. Rent.. Number of Inmates. No. (in Situation. Height. Length. Breadth. Windows. Flooring. Fire-place. Ventilators. door. Weekly, or nightly,or per person. Under Over 9 years of ages. Under Over 9 years of ages. Floor, Aspect. ft. in. ft. in. ft. in. 1 2 3 4 5 6 i 7 &c. Staircase, if with windows or skylight Number Privies Situation Material Receptacles .. -J Capacity Water-supply Situation Taps, where situated. Date Sinks Dustbin Yard—size of uncovered area Pavement Laundry Signature of Owner Note. I,. Inspector for the Commissioners of Sewers of the City of London, do certify that the above schedule contains a true account of the matters to which it relates ; also that I have examined the privies, drains sinks, and water-supply in the above house, and do find the same to be in an efficient aud satisfactory condition ; also that the house generally is in eood repair, perfectly clean, and free from disagreeable smell. Date, signedInspector.